Education, the brain and dementia: neuroprotection or compensation?: EClipSE Collaborative Members -- Brayne et al. 133 (8): 2210 -- Brain

© The Author(s) 2010. Published by Oxford University Press on behalf of Brain.
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Education, the brain and dementia: neuroprotection or compensation?
EClipSE Collaborative Members
Carol Brayne1, Paul G. Ince2, Hannah A. D. Keage1, Ian G. McKeith3, Fiona E. Matthews4, Tuomo Polvikoski3 and Raimo Sulkava5

1 Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, UK 2 School of Medical and Biomedical Sciences, University of Sheffield, Sheffield S10 2RX, UK 3 Institute for Ageing and Health, University of Newcastle, Newcastle NE4 5PL, UK 4 Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge CB2 0SR, UK 5 School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio 70210, Finland

Correspondence to: Dr Hannah Keage, Institute of Public Health, University of Cambridge, Robinson Way, Cambridge CB2 0SR, UK E-mail: hk323@medschl.cam.ac.uk


The potential protective role of education for dementia is an area of major interest. Almost all older people have some pathology in their brain at death but have not necessarily died with dementia. We have explored these two observations in large population-based cohort studies (Epidemiological Clinicopathological Studies in Europe; EClipSE) in an investigation of the relationships of brain pathology at death, clinical dementia and time in education, testing the hypothesis that greater exposure to education reduces the risk of dementia. EClipSE has harmonized longitudinal clinical data and neuropathology from three longstanding population-based studies that included post-mortem brain donation. These three studies started between 1985 and 1991. Number of years of education during earlier life was recorded at baseline. Incident dementia was detected through follow-up interviews, complemented by retrospective informant interviews, death certificate data and linked health/social records (dependent on study) after death. Dementia-related neuropathologies were assessed in each study in a comparable manner based on the Consortium to Establish a Registry for Alzheimer's Disease protocol. Eight hundred and seventy-two brain donors were included, of whom 56% were demented at death. Longer years in education were associated with decreased dementia risk and greater brain weight but had no relationship to neurodegenerative or vascular pathologies. The associations between neuropathological variables and clinical dementia differed according to the ‘dose’ of education such that more education reduced dementia risk largely independently of severity of pathology. More education did not protect individuals from developing neurodegenerative and vascular neuropathology by the time they died but it did appear to mitigate the impact of pathology on the clinical expression of dementia before death. The findings suggest that an understanding of the mechanisms leading to functional protection in the presence of pathology may be of considerable value to society.


Key Words: dementia; education; brain; ageing


Abbreviations: CAA, cerebral amyloid angiopathy; CC75C, Cambridge City Over-75s Cohort; CI, confidence interval; EClipSE, Epidemiological Clinicopathological Studies in Europe; MRC CFAS, Medical Research Council Cognitive Function and Ageing Study; OR, odds ratio

Received February 22, 2010. Revised May 17, 2010. Accepted June 6, 2010.

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Education, the brain and dementia: neuroprotection or compensation?: EClipSE Collaborative Members -- Brayne et al. 133 (8): 2210 -- Brain